Provider Demographics
NPI:1275215485
Name:MUSHTAQ, MUHAMMAD SOHAIL
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:SOHAIL
Last Name:MUSHTAQ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5946 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3235
Mailing Address - Country:US
Mailing Address - Phone:917-325-2615
Mailing Address - Fax:
Practice Address - Street 1:5946 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3235
Practice Address - Country:US
Practice Address - Phone:917-325-2615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program